PCBoard USER RATIO MONITOR v1.6
                              Registration Form
                Please support shareware by registering it.
                
                        Remit To:     Robert Neal        
                                      317 Hickory
                                      Romeoville, IL  60441   
    Support BBS (815) 886-3233 (v.32bis) and (815) 886-9381 (v.32bis)
--------------------------------------------------------------------------
                           ** REGISTRATION **

Registration Options (select one):

[ ] - Registration key information via support BBS       $15.00      _____
       Please be sure you have an account prior
       so that I may leave you a private message
       addressed to you with registration information.
       You may also register ONLINE with VISA/MC/AMEX
       and Discover by calling the support BBS and
       typing CHARGE at the main menu prompt.

[ ] - Registration key letter via the U.S. Mail          $15.00      _____


[ ] - Registration key letter plus current version       $20.00      _____
       on disk. Disk choice: [ ]-5.25"  [ ]-3.25"


                                                   Total ->         ______


    ** Payment by Check (U.S. Bank or branch) or Money Order only **
                        Thank you for your support.             
--------------------------------------------------------------------------

   Name: _________________________________
   
Address: _________________________________

         _________________________________
         
BBS Name to enter in registration (30 char max)          Phone number

 _______________________________________            (    ) _____ - ________  

                                                    Baud Supported: _______

---------------------------------------------------------------------------

Fold at the page break below with the printing facing out.  Then fold
letter style, exposing the mailing address and hiding your information.
If necessary, staple check to the mailer, then staple or tape sides and top.

_________________________________                                     Place

_________________________________                                     Stamp

_________________________________                                     Here





                                         Robert Neal         
                                         317 Hickory         
                                         Romeoville, IL  60441    U.S.A.


PCBURMv1.6